For the gastrointestinal tract including the esophagus and stomach, a treatment method for cutting off mucous membrane with an endoscope is widely adopted. Japanese Utility Model Application KOKAI Publication No. 6-75402 discloses a method for cutting off mucous membrane by sucking the mucous membrane into a transparent hood attached to the distal end of an endoscope, and constricting the base of the sucked membrane with a high frequency snare introduced into the endoscope.
For the esophagus, an attempt is being made to use a method for cutting off mucous membrane with a combination of a sheath 1 and an endoscope 2 as shown in FIG. 1. In general, the sheath 1 used for this method has a guide channel 3 for inserting therein the endoscope 2, a guide channel 4 for inserting therein a high frequency snare 5, and an obliquely cut distal end. A space between the endoscope 2 inserted in the guide channel 3 and the sheath 1 is sealed at the proximal end side (not shown). When using it, at first, the sheath 1 is inserted into the esophagus and then, the endoscope 2 is inserted into the sheath 1. Mucous membrane 6 is sucked by the endoscope 2 into the guide channel 3 of the sheath 1, thereby constricting and cutting off the base of the mucous membrane 6 with the high frequency snare 5. There is a case where diseased mucous membrane is cauterized, instead of being cut, using argon beam plasma, a laser or a high frequency probe.
The above-described conventional methods can cut off diseased mucous membrane with a diameter of, at maximum, about 2 cm, and accordingly, their applicability is limited by the size of a diseased area. Especially, in the case of xe2x80x9cBarrett Esophagusxe2x80x9d which is a disease rapidly increasing, a columnar epithelium tissue to be cut off extends over almost the entire inner surface of the lumen at a location separated by 3-5 cm or more from the esphagogastric junction. Therefore, in the conventional methods, it is difficult to cut off, at one time, the entire tissue to be cut off, and hence it is necessary to divide such a large diseased area into portions and cut it off one by one.
It is the object of the invention to provide an improved endoscopic treatment system capable of efficiently cutting off even a large diseased area.
According to an aspect of the present invention, there is provided an endoscopic treatment system for executing, at a predetermined portion of an esophagus, at least one of localized injection into submucosa, peeling off mucous membrane, and cutting off of mucous membrane. This system comprises an endoscope having an insertion section provided with at least one channel therein, the endoscope being used for observing a target inner portion of a body; and a plurality of treatment tools for treating the target inner portion. The treatment tools include a syringe needle for executing localized injection into submucosa, forceps for gripping mucous membrane, and at least one knife for executing at least one of peeling off mucous membrane and cutting off of mucous membrane. The at least one knife comprises one of a needle-shaped knife and a flat knife. This system further comprises an endoscopic guide tube to be inserted into the esophagus, and having a main channel for inserting therein the endoscope, and at least one sub channel for inserting therein each of the treatment tools. Thus, each of the treatment tools can be made to approach the target inner portion via one of the endoscope and the endoscopic guide tube.
In the system of the invention, a plurality of strip areas are formed in the esophageal mucous membrane by forming a plurality of longitudinal incisions and one circumferential incision in the esophageal mucous membrane, and are sequentially peeled off the esophagus. Thus, a wide area of esophageal mucous membrane can be reliably and completely peeled off. Moreover, the cut-off mucous membrane can be collected easily, which enables an efficient and accurate histological diagnosis of the cut-off mucous membrane.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.